8 Things You Probably Didn’t Know About Viral Hepatitis

Hepatitis is one of those conditions often shrouded in misinformation, confusion and negative stigma — but it shouldn’t be that way.

At a basic level, hepatitis is inflammation of the liver. It’s often your body’s way of responding to the destruction caused by one of the hepatitis viruses, but there are other ways to develop hepatitis, too.

Here’s everything you’ve ever wondered about what viral hepatitis really is.

The different types of hepatitis

Viral infection is the most common cause of hepatitis, but it can also be caused by exposure to toxins (including alcohol) or autoimmune disorders.

While there are different types of hepatitis, many of them share the same symptoms. These include:

• Jaundice (yellow skin and eyes)
• Dark urine (think: Coca-Cola dark)
• Nausea or vomiting
• Abdominal pain

So, what about all the different types of viral hepatitis?

To make it simple, the different letters associated with hepatitis each signify a different strain of the virus that causes liver inflammation. The five most common hepatitis viruses are labeled A, B, C, D and E.

John Scott, MD, an infectious disease doctor at the Hepatitis and Liver Clinic at Harborview Medical Center, says the most prevalent types in the U.S. are hepatitis B and hepatitis C.

Here is a breakdown of all the letters:

Hepatitis A

The hepatitis A virus is typically spread through contaminated food or water, a key difference from hepatitis B and C. It’s uncommon in the U.S. but affects more than 150 million people worldwide.

Symptoms of hepatitis A typically appear two to seven weeks after exposure and include nausea, diarrhea, fever, fatigue, dark urine and clay-colored stool.

A vaccine to prevent hepatitis A exists, but there isn’t currently an antiviral treatment for those who are exposed to the virus. However, if you aren’t vaccinated and are exposed to the virus, it’s still recommended that you get vaccinated within two weeks of exposure.

The body typically clears the virus on its own, and most people find that their liver heals completely after six months with no permanent damage.

Hepatitis B

Hepatitis B is the most common type of viral hepatitis in the world. More than 250 million people live with a chronic infection caused by the virus, meaning it lasts longer than six months. Unfortunately, there’s no way to predict whether you’ll develop a chronic infection if you’re exposed to the virus.

The hepatitis B virus spreads through contact with the blood, semen or other bodily fluids from someone with an active infection. Most chronic hepatitis cases in the U.S. are among immigrants who contracted the infection in another country as children. Mothers from this group, specifically, are at a high risk of transmitting the infection to their newborns.

“In my practice, I see many patients who received hepatitis B from their mothers,” says Scott. “If a mother had the virus during childbirth, she could transmit it to her child. Many of those patients are from Asia, specifically China, Korea, Southeast Asia, the South Pacific and a fair number from the Horn of Africa.”

There are many reasons why transmission is more common in these countries, including reduced access to vaccines and the high cost of disease prevention, especially in more rural areas.

Hepatitis B can also be transmitted through sex and drug use. In fact, unsafe sex and injection drug use in the U.S. are the most common ways people develop an acute (or short-term) hepatitis B infection.

Hepatitis C

Hepatitis C, on the other hand, is almost exclusively a bloodborne virus.

“I have seen a lot of patients get hepatitis C through injection drug use,” says Scott. “Some get it through blood transfusions.”

And while both hepatitis B and C affect the liver, they reproduce in completely different ways.

“The way hepatitis B and C replicate in the body is different,” says Scott. “Hepatitis B uses deoxyribonucleic acid, or DNA, to replicate after it infects liver cells. Hepatitis C, on the other hand, uses ribonucleic acid, or RNA, to replicate after infection. This has implications for treatment and cancer risk.”

For reference, chickenpox, oral herpes and smallpox are examples of DNA viruses, whereas COVID-19, influenza and HIV are examples of RNA viruses.

Hepatitis D and E

Hepatitis D and E are rarer forms of viral hepatitis. Hepatitis D is bloodborne. It’s what is called a “satellite virus” because it can only cause infection in someone who is already infected with hepatitis B. Like hepatitis B, hepatitis D can be either acute or chronic. There’s no vaccine for hepatitis D, but the hepatitis B vaccination can prevent hepatitis D.

Hepatitis E is similar to hepatitis A; both are transmitted through consuming something that was contaminated by fecal matter, are more prevalent in Asian or African countries and typically clear from the body within six months with no lasting damage to the liver. 

8 surprising facts about hepatitis

Here are some facts you probably didn’t know about the most common types of viral hepatitis:

Hepatitis is largely preventable

Effective vaccines are available to prevent hepatitis A and B transmission. These vaccines have been around for many years and are extremely safe and effective. Most people receive the hepatitis A and B vaccines at birth, but if you’re not sure whether you received the vaccine, you can talk to your doctor.

Hepatitis C can be best prevented by avoiding contact with blood or other bodily fluids.

“You should use barrier protection during sex, have partners get tested and vaccinated, and practice safe injection practices to prevent transmission,” says Scott.

You might not always know if you have hepatitis

Some people can live for years with viral hepatitis without knowing it because they have no symptoms, says Scott. This is especially important to keep in mind for pregnant people who need prenatal care.

“Pregnant women may have a high viral load, in which case the risk of transmission during childbirth is greater,” says Scott. “Even if the baby is given prophylaxis — the treatment given to newborns to prevent infections or diseases — there’s still a 10% chance that the virus can be transmitted to the baby.”

Fortunately, in these cases, doctors can give pregnant people antivirals during the second trimester to reduce the risk of transmission, but it’s an important reminder for those who might be pregnant to get screened and treated for viral hepatitis.

Some types of viral hepatitis can increase your cancer risk

People with hepatitis B, C and D are at increased risk for liver cancer, especially those with hepatitis B and D.

“This is another reason why folks should get tested, know their status and get plugged into care for possible treatment and screening for liver cancer,” says Scott.

The most common form of liver cancer is called hepatocellular carcinoma. If it is caught early with a blood test or ultrasound, it can often be cured with localized treatment during same-day procedures, and without any chemotherapy.

There are unexpected ways to transmit hepatitis

Scott has seen viral hepatitis transmitted in some unexpected ways.

“I used to do work in prisons and would see hepatitis C transmitted through fist fights or through homemade tattoos,” says Scott.

You can share a drink with someone who has hepatitis

It’s a misconception that you can’t share cups or utensils with someone who has chronic hepatitis B or hepatitis C.

Definitely wash your hands and keep your distance from others if you have other kinds of active hepatitis, but for hepatitis B and C, you don’t need to take those kinds of precautions.

“It’s OK to hug, share utensils and cups, and kiss. I think it’s really important for people to know this,” says Scott.

Certain medications increase your risk of reactivating hepatitis

It’s important to be screened for hepatitis B before starting chemotherapy or immunosuppressant medications, because these treatments can increase your risk of reactivating the virus if you’ve been infected, even if you didn’t know you had it.

Hepatitis C is curable

The scientific discovery of hepatitis C is as old as your favorite millennial — it wasn’t identified until 1989. Although it’s a recent discovery, incredible progress by researchers over the last few decades has led to the development of a cure for hepatitis C.

“We went from discovery to nearly a 100% cure rate in 25 years, with a very easy, short course of therapy,” says Scott. “It’s one of those unknown miracles of medical science, and a lot of the research was done in the United States.”

Hepatitis B isn’t curable … yet

Although a cure for hepatitis B has not yet been found, 95% of people with an acute infection recover on their own. If you have chronic hepatitis B, your symptoms can be managed with medication.

“The medications have to be taken long-term — years to decades — but they are really easy: once-a-day medication by mouth,” says Scott. “Unfortunately, they’re expensive, so there can be a financial barrier.”

Another note to remember

Be kind when talking about hepatitis. Whether or not someone has a hepatitis infection doesn’t determine their character.

Plus, you never know who might be dealing with it — or who loves someone who does.